Abnormal Prenatal Screening Results: A Guide for Expecting Mothers

Q: Abnormal Prenatal Screening Results: A Guide for Expecting Mothers

Please follow up with the Rheumatology and Immunology department and inform the physician that you are 9 weeks pregnant. <br>It is essential to find a hospital that specializes in high-risk obstetrics and has a neonatal intensive care unit for a safer delivery. <br>Antiphospholip

Abnormal prenatal examination report?

Dr.
Tseng is currently about 9 weeks pregnant and underwent blood tests at the hospital.
Initially, the STS RPR test was reactive, but subsequent tests for TPPA and FAT-ABS were negative, which preliminarily rules out syphilis.
However, the immunologist tested for other autoimmune diseases, revealing the following results: Lupus LA1 at 85.8 (reference range: 31-44), Lupus LA2 at 38.7 (reference range: 30-38), and a LA1/LA2 ratio of 1.88 (reference range: 0.8-1.2).
These three results are abnormal.
Other tests showed Anti-phospholipid IgG as negative, Anti-B2 glycoprotein I at 2.2 (negative), Anti-Cardiolipin IgG at 1.9 (negative), RA at <9.75 (reference range: 0-15.9), and ANA as negative.

What does it mean that only Lupus LA1, Lupus LA2, and the LA1/LA2 ratio are abnormal while the others are within normal limits? Is it possible for these three values to be abnormal without any underlying issues? Please help interpret these findings.

Xiao Xiang, 20~29 year old female. Ask Date: 2015/05/27

Dr. Lin Wenbin reply Obstetrics and Gynecology

Please follow up with the Rheumatology and Immunology department and inform the physician that you are 9 weeks pregnant.
It is essential to find a hospital that specializes in high-risk obstetrics and has a neonatal intensive care unit for a safer delivery.
Antiphospholipid syndrome may lead to vascular thrombosis, miscarriage, and preterm labor.
Previously, your blood test for syphilis was a false positive (similar to your initial test).
Now, you have tested for Anti-phospholipid IgG, Anti-β2 glycoprotein I, and Anti-Cardiolipin IgG (as in your later tests), but these three markers can sometimes appear transiently and then disappear.
Therefore, the physician should still consider clinical symptoms for assessment.
Regarding your concerns, I have discussed them with the head of our hospital's Rheumatology and Immunology department.
He recommends that you visit the outpatient clinic for further evaluation, as there are many other antibody tests that can be performed in addition to assessing clinical symptoms.
Although your current condition seems stable, it is advisable to check for other tests you have not undergone yet.
Pay close attention to any signs of hypertension or preterm labor, as well as other symptoms such as fever, fatigue, poor appetite, rash, oral ulcers, hair loss, joint swelling and pain, purpura, edema, and headaches.

Reply Date: 2015/05/27

More Info

Understanding abnormal prenatal screening results can be a daunting experience for expecting mothers, especially when faced with complex laboratory findings. In your case, the results indicate some abnormalities in the lupus anticoagulant (LA) tests, specifically LA1 and LA2, along with their ratio. Let’s break down what these results mean and how they might impact your pregnancy.

Understanding the Results
1. Lupus Anticoagulant (LA) Tests:
- The lupus anticoagulant tests are part of a broader evaluation for antiphospholipid syndrome (APS), which is an autoimmune disorder that can increase the risk of blood clots.
- LA1 and LA2 are specific tests that measure different aspects of lupus anticoagulant activity. Your results show LA1 at 85.8 (normal range: 31-44) and LA2 at 38.7 (normal range: 30-38), indicating that LA1 is significantly elevated.

2. LA Ratio:
- The LA1/LA2 ratio is also important, as it helps interpret the significance of the LA levels. Your ratio is 1.88, which is above the reference range of 0.8-1.2. This suggests a potential imbalance in the lupus anticoagulant activity.

3. Other Tests:
- The other tests you mentioned, including Anti-phospholipid IgG, Anti-B2glycoprotein I, Anti-Cardiolipin IgG, and RA, returned negative or within normal limits. This is reassuring as it suggests that there may not be a widespread antiphospholipid syndrome, but the elevated LA1 and LA2 still warrant attention.

Implications for Pregnancy
The presence of elevated lupus anticoagulant levels can be concerning, as it may increase the risk of complications during pregnancy, such as miscarriage, preterm birth, or placental insufficiency. However, it is essential to note that not all women with elevated LA levels will experience these complications, and many have successful pregnancies.

Next Steps
1. Consultation with a Specialist:
- It is crucial to discuss these results with your healthcare provider, preferably a maternal-fetal medicine specialist or a rheumatologist who understands the implications of lupus anticoagulant in pregnancy. They can provide a more tailored assessment based on your overall health and pregnancy history.

2. Monitoring:
- Your healthcare provider may recommend closer monitoring throughout your pregnancy. This could include regular ultrasounds to assess fetal growth and placental function, as well as blood tests to monitor your coagulation status.

3. Preventive Measures:
- Depending on your provider's assessment, they may consider preventive measures, such as low-dose aspirin or anticoagulant therapy, to reduce the risk of complications associated with elevated lupus anticoagulant levels.

4. Lifestyle Considerations:
- Maintaining a healthy lifestyle, including a balanced diet, regular prenatal care, and avoiding smoking or excessive caffeine, can also contribute positively to your pregnancy outcome.

Conclusion
In summary, while the elevated lupus anticoagulant levels in your tests are noteworthy, they do not necessarily indicate an immediate problem. With appropriate monitoring and management, many women with similar findings go on to have healthy pregnancies. It is essential to maintain open communication with your healthcare team and follow their recommendations closely. Remember, each pregnancy is unique, and your healthcare provider is your best resource for navigating any concerns you may have.

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